By Iris Smith, Ph.D.
Research has indicated that people with disabilities have an increased risk for substance use disorders (SUDs). However, research on the patterns of use, treatment access, and outcomes is limited. A growing body of research has found individuals with mild or borderline intellectual disabilities, schizophrenia, schizoaffective disorder, and bipolar disorder are overrepresented in substance abuse treatment programs.1,2,3 A recent study estimated that 1 in 4 adults in the U.S. lives with a disability.4 The term “disability” covers a wide range of conditions that can impact function and quality of life including sensory disorders (vision, hearing, speech), physical limitations, and psychiatric conditions. Disabilities may be acquired as the result of lifestyle, injuries or accidents, or congenital (fetal alcohol spectrum disorder) and can occur regardless of socioeconomic status or ethnicity.
A study of a nationally representative sample of substance abuse treatment facilities in 40 states (n=525) examined substance use and misuse patterns among adults with selected self-reported disabilities compared to individuals without disabilities. The sample was drawn from the 2020 US National Alcohol Survey and controlled for socio-demographics, self-reported symptoms of depression/anxiety, physical health, quality of life, and chronic pain.5 The results of the study indicated that most facilities had a variety of barriers to physical accessibility and a lack of services and physical accommodations for persons with disabilities. 18% of the sample reported some type of disability (42.8 million individuals in the study). Among those reporting disability, 52% reported difficulties walking or climbing stairs; 31% reported being blind or deaf; and 32% reported being unemployed due to a disability. Persons with disabilities (PWDs) tended to be older, less educated, less likely to be married and more likely to report that their quality of life was fair or poor. Having a disability was associated with drug use, including prescription medications and nicotine, but not with the intensity of alcohol or marijuana use. Chronic pain, however, was associated with “high intensity alcohol use in addition to drug use and accounted for 38% of the association between disability nicotine and any drug use. The results of this study highlight the importance of screening for disabilities by substance abuse intervention and treatment programs.
The authors of this study also emphasized the need for appropriate accommodation for disabilities including chronic pain. PWDs often experience greater difficulty accessing appropriate treatment and have poorer treatment outcomes compared to individuals without disabilities. The need for accommodations such as alterations to the physical environment, medications, and treatment approaches vary depending on the nature of the disability.
1 Didden R, VanDerNagel J, Delforterie M, Van Duijvenbode N (2020). Substance Use Disorders in People with Intellectual Disability. Current Opinion Psychiatry; 33, pg. 124-129.
2Gold AK, Otto MW, Deckersbach T, Sylvia LG, Nierenberg AA, Kinrys G. (2018) Substance Use Comorbidity in Bipolar Disorder: A Qualitative Review of Treatment Strategies and Outcomes. American Journal of Addiction; 27(3); pg. 188-201.
3 Archibald L, Brunette MF, Wallin DJ, Green AI (2019).Alcohol Use Disorder and Schizophrenia or Schizoaffective Disorder. Alcohol Research: Current Reviews 40 (1):06. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6927747/
4 Reif S, Karriker-Jaffe K, Valentine A, Patterson D, Mericle AA, Adams RS, Greenfield TK (2022). Substance Use and Misuse Patterns and Disability Status in the 2020 US National Alcohol Survey: A Contributing Role for Chronic Pain. Disability and Health Journal 15; pg. 101290
